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Original Article
 
Biliary ascariasis in the etiology of recurrent pyogenic cholangitis in an endemic area
Mohammad S. Khuroo1, Naira S. Khuroo2, Mehnaaz S. Khuroo3
1MBBS, MD, DM, FACP,FRCP, MACP; Director & Consultant Gastroenterology, Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India.
2MBBS, FMIR (KFSH&RC, Riyadh); Consultant Radiologist, Dr. Khuroo's Medical Clinic, Srinagar, Kashmir, India.
3MD, Assistant Professor, Department of Pathology, Government Medical College, Srinagar, Kashmir, India.

Article ID: 100030IJHPDMK2015
doi:10.5348/ijhpd-2015-30-OA-5

Address correspondence to:
Prof. Mohammad Sultan Khuroo
MD, DM, FACP, FRCP, MACP, Dr. Khuroo's Medical Clinic, Sector 1
Sher-e-Kashmir Colony
Qamarwari, Srinagar, Kashmir, J&K 190010
India

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How to cite this article
Khuroo MS, Khuroo NS, Khuroo MS. Biliary ascariasis in the etiology of recurrent pyogenic cholangitis in an endemic area. Int J Hepatobiliary Pancreat Dis 2015;5:22–29.


Abstract
Aims: The role of biliary ascariasis in etiology of recurrent pyogenic cholangitis in endemic areas has not been well studied.
Methods: We studied 30 patients of recurrent pyogenic cholangitis with brown pigment stones and 30 patients with cholesterol gallstones. Stones from 22 patients (11 brown pigment stones and 11 gallstones) were examined by infrared spectrophotometry to substantiate the classification of stones done on visual inspection. Biliary calculi were considered to be associated with Ascaris lumbricoides in those with: previous documented evidence of biliary ascariasis, bile specimens containing ova of Ascaris lumbricoides on light microscopy and worms, worm fragments or their ova forming the nidus of stones on histological examination.
Results: Bile cultures grew microorganisms in 24 (80%) patients with recurrent pyogenic cholangitis while only one patient with gallstones grew Escherichia coli from bile. None of the patients in either group had past or persisting evidence of clonorchiasis. Five patients had previous documentation of biliary ascariasis. In three patients bile contained ova of Ascaris lumbricoides and stones in 22 patients contained worm, worm fragments or their ova on histological examination. Overall 24 (80%) patients with recurrent pyogenic cholangitis had past or persistent evidence of biliary ascariasis while only one patient with gallstones had worm fragments on histopathology of stones (p < 0.001).
Conclusion: We conclude that in endemic areas bacterial infection of the bile ducts in recurrent pyogenic cholangitis occurs with biliary invasion by Ascaris lumbricoides and dead worms, their fragments or ova form nidus of brown pigment stones formation in such patients.

Keywords: Ascaris lumbricoides, Biliary ascariasis, Recurrent pyogenic cholangitis

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Author Contributions:
Khuroo Mohammad Sultan – Substantial contribution to concept and design, Acquisition and analysis of data and interpretation of data, Drafting of article, revising critically for intellectual content, Final approval of the version to be published
Khuroo Naira Sultan – Substantial contribution to concept, design, Acquisition of data, Drafting of article, Final approval of the version to be published
Khuroo Mehnaaz Sultan – Substantial contribution to concept and design, Analysis and interpretation of data, Drafting of article, revising critically for intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Khuroo Mohammad Sultan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Mohammad Sultan Khuroo is Director, Consultant Gastroenterologist and Hepatologist at Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Srinagar, J&K, India. He earned undergraduate degree (MBBS) from University of Kashmir, J&K, India and postgraduate degree form MD from Department of Medicine, Government Medical College, Srinagar, J&K, India, DM from Postgraduate Institute of Medical Research (PGIMER), Chandigarh, India. He was conferred FRCP from Royal College of Physicians (Edinburgh) in January 1997, FACP and MACP from American College of Physicians in January 1998 & April 2000 respectively. He has published 240 research papers in national and international academic journals and authored three books. His research interests include hepatitis E, biliary Parasites and bleeding peptic ulcer disease.



Naira Sultan Khuroo is Consultant Radiologist at Dr Khuroo's Medical Clinic, Srinagar, J&K, India. She earned the undergraduate degree MBBS from Kashmir University, India and postgraduate degree form Fellowship in Medical Imaging and Radiology (FAIMER) from King Faisal Specialist Hospital & Research Centre, Riyadh, KSA. She has published 15 research papers in national and international academic journals and authored one book. Her research interests include Hepatobiliary Parasites, Tropical Calcific Pancreatitis, and Interventional radiology.



Mehnaaz Sultan Khuroo is Assistant Professor at Department of Pathology, Government Medical College, Srinagar, J&K, India. She earned undergraduate degree (MBBS) from Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India and postgraduate degree MD from Department of Pathology, Sri Ramachandra Medical College and Research Institute, Deemed University, Chennai, Tamil Nadu, India. She has published 23 research papers in national and international academic journals and authored 2 books and 2 book chapters. Her research interests include Meta-analysis, Gastrointestinal Pathology and Hematopathology.